SURNAME*FIRST NAME*ADDRESS - Mailing (City / Town and Postal Code*LocalPhone*EMAIL* CLAIMING WAGES?YesNoIF 'Yes' PLEASE ENTER SIN NUMBER First Middle Last DIRECT DEPOSIT?YesNoIF 'Yes' BANKING INFO MUST BE SUBMITTED ACTIVITY INFORMATION- REQUIREDACTIVITY ASSOCIATED WITH CLAIM*SelectMeetingConferenceTrainingNAME OF ACTIVITY*EXPENSE TRAVEL Check all that apply. Mileage MILAGE Milage Input*KM @ $0.56Travel - Milage ResultParking PARKING Parking Input*Travel- Parking ResultTAXI TAXI Taxi Input*Travel - Taxi - ResultOtherr OTHER Other Input*Travel - Other - ResultTravel TotalTravel TotalPlease specify nature of other expenses*ACCOMMODATION Check all that apply. Hotel HOTEL hotel Input*Accommodation - Hotel - ResultPRIVATE ACCOMMODATION/LODGING PRIVATE ACCOMMODATION/LODGING How Many Days?*DAYS @ $50.00Private accomodation resultMEALSLEFT HOME DATE* Date Format: MM slash DD slash YYYY TIME* : HH MM AM PM ARRIVED HOME DATE* Date Format: MM slash DD slash YYYY TIME* : HH MM AM PM Check all that apply (Effective Date: October 1, 2019))BREAKFAST BREAKFAST Breakfast Input*@ $20.65Meals - Breakfast resultLUNCH LUNCH LUNCH Input*@ $20.90Meals -Lunch resultDINNER DINNER Dinner Input*@ $51.25Meals - Dinner resultINCIDENTALS INCIDENTALS INCIDENTALS Input*@ $17.30Meals - Incidentals resultTravel TotalMeals TotalWAGES (includes top-up) For Treasury Board and CSE members claiming wages – please attach your approved leave document before submitting this form.CLASSIFICATION & LEVELDAILY RATE $DAYS CLAIMEDDAILY RATE TOTALAdd field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 2Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 3Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 4Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 5Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 6Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 7Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 8Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 9Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 10Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 11Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 12Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 13Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 14Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 15MISCELLANEOUS Check all that apply. FAMILY CARE CLAIM FAMILY CARE CLAIM $*Misc - Family Care resultOTHER OTHER Description*Amount*Other Bottom ResultDescriptionAmountOther Bottom Result TwoAdd field +DescriptionAmountAdd Result 1Add field +DescriptionAmountAdd Result 2Add field +DescriptionAmountAdd Result 3Add field +DescriptionAmountAdd Result 4Add field +DescriptionAmountAdd Result 5Add field +DescriptionAmountAdd Result 6Add field +DescriptionAmountAdd Result 7Add field +DescriptionAmountAdd Result 8Add field +DescriptionAmountAdd Result 9Add field +DescriptionAmountAdd Result 10Miscellaneous TotalMiscellaneous TotalDID YOU RECEIVE AN ADVANCE?YesNoIF 'Yes' INDICATE THE AMOUNT*Advance TotalComments Please provide any additional information or requests that are relevant to your claimComment BoxNET CLAIM (before statutory deductions)TOTAL ALL EXPENSES To help faster processing: Include all receipts For Treasury Board and CSE members claiming wages – please attach your approved leave document before submitting this form. Include FAMILY EXPENSE FORM (if applicable) If DIRECT DEPOSIT was requested, please include a copy of a void cheque PDF, .jpg, .png, .docx files accepted max 10MB file size. ATTACH FILES Drop files here or * By checking this box, I certify that these expenses indicated were incurred for Union Business and that not part of said expenses were or will be reimbursed from any other source